An overview of bilateral synchronous inferior petrosal sinus sampling (BSIPSS) in the pre‐operative assessment of Cushing's disease

Abstract

This study examines the role of bilateral synchronous inferior petrosal sinus sampling (BSIPSS) in resolving two major issues in the pre-operative assessment of Cushing's disease, namely proof of pituitary dependent disease and accurate lateralisation of tumour within the pituitary. BSIPSS was technically successful in 16 of 20 patients. The central to peripheral ACTH gradients, supporting the diagnosis of pituitary dependent disease, was greater than 2.0 (2.0-27.2) in all patients with histologically proven ACTH-secreting pituitary tumours and in those who remained in remission following pituitary surgery. In addition, BSIPSS accurately localised the site of the tumour within the pituitary in 13 of the 16 technically satisfactory studies and thus contributed to the outcome of surgical treatment. In contrast CT scan demonstrated a definite tumour in only two patients.

Diagnostic accuracy of Bilateral Inferior Petrosal Sinus Sampling: The Experience of a Tertiary Centre

“…Teramoto et al [28] described in 1993 a type of selective venous sampling directly from the cavernous sinus. The advantage of this technique is the much greater C/P ACTH gradients, diminishing false negatives by minimizing the impact of errors in the measurement of ACTH [29] and by avoiding the wide variations in ACTH levels of blood sampled from the inferior petrosal sinus [30,31]. This author and colleagues obtained a correct lateralization in 91 % of the patients submitted to cavernous sinus sampling [32], Graham et al in 83 % [33] and Burkhardt et al in 82 % [34].…”

Metyrapone pre‐treated inferior petrosal sinus sampling in the differential diagnosis of ACTH‐dependent Cushing's syndrome

“…Successful lateralization of the pituitary lesion by IPSS has not been as accurate as for the distinction between pituitary and non-pituitary sources of ACTH production (Boolell et al, 1990;Calao et al, 1993;de Herder et al, 1994;Landolt et al, 1994), possibly because many lesions have midline components. Using the left : right or right : left post-CRF ACTH ratios of >1 .…”

Morphology of the groove of the inferior petrosal sinus: application to better understanding variations and surgery of the skull base

“…The conventional carotid vertebral angiogram/venogram has been an important tool for visualizing the IPS [ 5 ], which is important in other ways apart from venous blood drainage. In medical application it is used in bilateral sampling, which is valuable in combination with corticotropin-releasing hormone stimulation both for diagnosing Cushing’s disease and also for distinguishing it from ectopic adrenocorticotropic hormone (ACTH) levels [ 7 - 12 ]. Additionally, owing to its position and ease of access, the IPS is routinely used for transvenous embolization of cavernous sinus dural arteriovenous fistulas (CSDAVFs), even in cases when the IPS is radiologically occluded [ 6 , 12 - 15 ].…”